Provider Demographics
NPI:1891211058
Name:FLECK, JENNA STARR (AGPCNP-BC)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:STARR
Last Name:FLECK
Suffix:
Gender:F
Credentials:AGPCNP-BC
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:STARR
Other - Last Name:MCGRATH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10700 PARK PL
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHN
Mailing Address - State:IN
Mailing Address - Zip Code:46373-8666
Mailing Address - Country:US
Mailing Address - Phone:800-509-2800
Mailing Address - Fax:219-365-3524
Practice Address - Street 1:10700 PARK PL
Practice Address - Street 2:
Practice Address - City:SAINT JOHN
Practice Address - State:IN
Practice Address - Zip Code:46373-8666
Practice Address - Country:US
Practice Address - Phone:800-509-2800
Practice Address - Fax:219-365-3524
Is Sole Proprietor?:No
Enumeration Date:2017-08-19
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201042875RN163W00000X
OR201801692NP-PP363L00000X
IN71011196A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse